Organization
DEACONESS HOSPITAL, INC
Active
Other names
Deaconess Medical Group - Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD M STIVERS (SR VICE PRESIDENT, CFO)
(812) 450-3296
Entity
Organization
Contact information
Practice address
4111 GATEWAY BLVD, NEWBURGH, IN 47630-8954
(812) 853-5300
(812) 858-4656
Mailing address
PO BOX 3407, EVANSVILLE, IN 47733-3407
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG1119
RR MCARE GROUP #
IN
Enumeration date
06/29/2006
Last updated
12/20/2007
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